Doc, I really appreciate this blog which I consider, by the way, the funniest blog on the Internet about hairloss. My question is about maintainance. You have written many times that baldness will catch up all of us sooner or later but, on the other hand, some people, mostly in their early twenties are still maintaining after ten years, their benefits of Finasteride. According to these: you think that those who are taking Finasteride will lose most of their retained hair, maybe at their late thirties or fourties? Or perhaps these people could get to keep their hair until they reach their fifties or sixties?

I know very well that you don’t like the guessing game but I am sure your professional experience gives you a better perspective about these topic.

You’re right in that I don’t like to guess, so I’m not going to do so here. The data is just not there. Finasteride hasn’t been around long enough to say whether it’ll maintain hair loss treatment benefits 30 or 40 years after you start taking it. What I do know is that it does still provide benefits after the 10 year mark for some men, because the medication has been available for about that long. Finasteride was around in a larger dosage (5mg) since 1992 to treat the prostate, but I don’t have data about hair loss treatment benefits in those that took the drug back then for prostate health.

The drug company Merck shows a slow loss of effectiveness over the first 5 years, but there is no published data beyond 5 years. I have had many patients starting this drug in their early to mid-twenties and over the 10 or so years the drug has been on the market, many of the men who reversed the balding in the crown have maintained all of the benefits. Unfortunately, I can not project this out for the length of time you are asking about.

(male) Hi, i was wondering something and had a question. When i cut my hair real short and stand under direct light you can see my scalp, but if i am in just regular light like out in the car i can not see it. The strange thing is when i let it grow out i cant see through it at all. I dont understand whats goin on. People say my hair looks thin at the top but the lady that does my hair says i have good fine thin curly hair. Could you please give me some insight? thanks.

Imagine looking out your window when you’re in an airplane on a sunny day and seeing some thin, short trees. You’d probably be able to see the ground in between them. Now imagine looking out that same window on a gloomy day and seeing thick, tall redwoods. You probably won’t be able to see the ground between the trees. Now apply that logic to the hair on your head.

If that doesn’t make sense, how about this: Fine hair has less hair bulk than coarser hair, so the longer the fine hair is, the more significant will be the bulk. People with fine hair have difficulty looking full-headed, because the bulk of the hair shaft is small.

You recently stated that you would need to see a well-controlled scientific study to be convinced that PRP would be worth the cost. I was wondering if you were aware of any such study. I’m sure doctors and patients alike would be eager to see the results if in fact a study is currently underway.

The popularity of PRP treatment seems to be increasing and I get the impression (just from what I read online) that more and more doctors are adopting the practice.

Platelet-rich plasma (PRP) is a great marketing gimmick, but there is no good scientific evidence that it has any value. Most of the studies that I do know of don’t provide the quality of data I demand before I’d consider using it. Also, we have not heard from the FDA, which may be interested in the claims made by those who promote it.

I am not aware of a well designed scientific study going on with good double blind controls, but maybe there is such a study being conducted. If so, when it is published, I will certainly know about it. As a surgeon quoted in this recent article about PRP says, “there currently is minimal evidence of this clinically and more research must be performed“.

What product will you recommend for hair thickening and to stop hair-loss. When do you think Follica will be ready with the miracle drug?

For hair thickening, there are a variety of products like volumizing shampoos and protein fibers that you can apply to your hair. I don’t have any specific recommendation for these, as they’re over the counter and you can try them as you like. Some work better than others to give the illusion of thicker hair, but none of them will stop hair loss.

As for information on Follica, please contact the company (here is their Consumer Inquiries form). I have no insider information.

Hey doc I wrote you here and after you mentioned the chimeric process I did a little research because frankly I had no idea what that was, and I’m convinced I am chimeric.

It’s literally like I have two different kinds of hair everywhere on my body. On my head I have brown normal hairs much like my father and Black thick really curly ones, I have noticed there are a few patches where the curly hair is more concentrated, it makes me look incredibly silly when my hair gets longer. The same goes to my body, except the black body hairs aren’t curly. Assuming I am chimeric (I understand no one really knows how frequent it really is, and I’m not going to get tested because i don’t care that much and don’t have the money), does this mean my different hair will inherit different balding genes? Have you dealt with anything like that before?

Sorry, but I just don’t have the answer to your question. In the real world things are not so theoretical and your guess is as good as mine. You should try to send me some photographs of what you’re seeing with the different hairs (you can blank our your face, as that is not important for us).

It’s not hair loss related, but I wanted to share something…

The Medical Board of California sends each licensed physician notification of doctors who are being investigated by them for a variety of problems as well as doctors who have been disciplined by the Medical Board. With the Michael Jackson fiasco in mind, I read about a doctor who is under investigation for overprescribing Endocet (a controlled narcotic). One patient who found the doctor through the Yellow Pages, received 7,912 tablets of Endocet over a 77 day period (1-2 pills per day for short periods of time should be normal). One of the excuses given as to why such a large amount of pills were needed included: the family dog ate them. I wonder what happened to the dog?

The Medical Board is given the responsibility to watch over the practices of doctors. They have told me privately that they do not have the resources to chase down every complaint, but they will open an investigation on doctors who practice outside what is considered the Standard of Care. I have been an expert witness for the state in the past and the actions of that one particular doctor just amazed me.

Thank you again for maintaining this blog. It’s very informative. I have two questions:

1. What does it generally mean when a man loses hair at the vertex first? I understand that every one is different, but do people who lose hair in the vertex and have little to no hair loss at the hair line tend to maintain their hair line? The Norwood scale suggests that hair loss usually begins with a receding hairline, with hair loss in the crown coming later. Also, I have noticed that men with receding hair lines generally state that they started to lose hair (in the front) in their early 20’s. Do men that make it to their late 20s with little to no recession tend to maintain strong hair lines, or have less recession?
2. I use minoxodil. However, I still have quite a bit of hair and don’t think it absorbs into my scalp very well. Even after 4 hours or so I can touch my head and my hands will be wet from the liquid sitting on my scalp. Should I use a scalp roller? I have read before that it may increase absorption. It seems relatively easy to use and inexpensive. So long as it does not cause any harm (or further hair loss) I would give it a shot. Thoughts?

Thanks again

1. Depending upon your genes, the balding may or may not start with thinning in the crown. If you keep your hairline into your 30s or so, you have a better chance that you will keep it — but some men do lose their hair later in life. I really can’t give you odds, as each case is unique. From your question, I am guessing that you’re losing hair in the crown and are worried about the hairline going, but I can’t provide you any clear comfort.
2. If you do not believe that regular minoxidil works well for you, try Rogaine Foam, which is reportedly easier to use and better on the absorption. I wouldn’t bother with the scalp roller until there have been some established trials that show it is worth using. Contributing author Dr. Bessam Farjo wrote about that recently.

Dr. Thank you for this informative site.D o you have any thoughts on using minoxidil other than Rogaine. DS Labs has there own formula DNC and a brand new formula DNC-L for advanced stages of balding. I don’t know if this company can be trusted due to it’s claims the their shampoo Revita will stop hair loss. It’s website is impressive and I do like the shampoo.

If you like the shampoo and it seems to be working for you, I’d keep using it. Claims on preventing hair loss may be in violation of permitted language from an FDA perspective if the formulation impacts the effectiveness of the minoxidil in their product. I believe if you want minoxidil, get it the generic way. If you want the minoxidil foam, you’ll have to get the name brand stuff. As for this lotion… well, it’s up to you. The combo products, without proper studies, just don’t do it for me. That kind of sums up my opinion.

I think it is easier to build a great website than it is to create a product that actually slows, stops, or reverses hair loss.

Snippet from the article:

Former tennis star Andre Agassi has admitted the lion mane-style hairstyle he sported during the 1990s was actually a wig, in extracts from his autobiography published in British newspapers Saturday.

Agassi said he wore a hairpiece held together with pins in his first Grand Slam final, the 1990 French Open final, and blamed his concerns that it would fall apart for losing the match to Andres Gomez.

Before the match he prayed “not for victory, but that my hairpiece would not fall off”, he writes in “Open”.

Read the rest — Agassi admits mane was a wig

Well, coming clean about his wig-wearing days is certainly one way to sell books. Here are some before and after photos for those that might not remember him with his mullet wig in the 90s:

I have been on propecia for about 6 months and it seems to have stopped my shedding. I read somewhere that Lexapro can cause hair loss. If i start taking Lexapro 10mg can it still cause hair loss even if i’m taking propecia?

The drugs that cause hair loss are not protected by taking Propecia. Keep in mind that Lexapro doesn’t cause hair loss for everyone taking it, but it is a possibility.